[Nutritional assessment of gluten-free diet. Is gluten-free diet deficient in some nutrient?]. / Valoración nutricional de la dieta sin gluten. ¿Es la dieta sin gluten deficitaria en algún nutriente?

INTRODUCTION: The gluten-free diet has traditionally been accepted as a healthy diet, but there are articles advocating that it may have some nutritional deficiencies. The current study assesses whether there was any change in the contributions of calories, essential elements, proportion of fatty acids, vitamins, minerals and fiber in children who were diagnosed with celiac diseases, comparing the diet with gluten prior one year after diagnosis with the diet without gluten to the year of diagnosis. The level of clinical or analytical impact that nutritional deficits could have was also assessed. MATERIAL AND METHODS: A prospective,descriptive, observational study in which information was collected from a dietary survey, anthropometric and analytical data at pre-diagnosis of celiac disease and following a gluten diet and one year after celiac disease diagnosis, under gluten-free diet. RESULTS: A total of 37 patients meet the study criteria. A decrease in the intake of saturated fatty acids was found, with an increase of monounsaturated fatty acids and an increase in the intake of phosphorus in the diet without gluten. A deficient intake of vitamin D was found in both diets. Clinically, at year of gluten-free diet there was an improvement in weight and size. Analytically, there was an improvement in hemoglobin, ferritin, vitamin D, and parathyroid hormone in plasma. CONCLUSION: The gluten-free diet has minimal deficiencies, similar to those present in the diet with gluten, with an improvement in the lipid profile by increasing the proportion of monounsaturated fatty acids to the detriment of saturated fatty acids.

Endoscopia digestiva en una unidad de gastroenterología pediátrica. Evolución en los últimos 9 años / Nine years experience of digestive endoscopy in a pediatric gastroenterology unit

Introducción. El desarrollo de la endoscopia disgestiva pediátrica ha permitido progresar notablemente en el campo de la gastroenterología pediátrica. Hoy en día no es solo una técnica puramente diagnostica, sino también una técnica terapéutica de primer orden. Objetivos. Describir los resultados en endopia digestiva pediátrica en una serie extensa en los últimos 9 años. Material y métodos. Revisión retrospectiva de las endoscopias realizadas entre los años 2005 y 2013, ambos inclusive. Resultados. La frecuencia media annual de endoscopias en los últimos 9 años ha aumentado en un 25%. La primera indicación es la sospecha de enfermedad celíaca seguida del dolor abdominal. La sospecha de trastorno eosinofílico ha aumentado significativamente en los últimos años como indicación y como hallazgo en las endoscopias digestivas altas. En cuanto a las endoscopias digestivas bajas destaca el alto índice de resultados de normalidad, que han disminuido a lo largo del tiempo. Conclusión. La endoscopia digestiva infantil en manos de un endocopista experto es una técnica segura. En los útlimos años las variaciones en relación a número, indicaciones y resultados de dicha técnica está en consonancia con el mayor desarrollo de la subespecialidad y con el avance en el estudio de patologías emergentes (AU)

Introduction. Pediatric gastrointestinal endoscopy development has allowed amjor progress in the field of pediatric gastroenterology. Currently, it is not just a purely diagnostic technique but also a prime therapeutic technique. Aims. To describe an extensive serie on pediatric endoscopy in the las 9 years. Material and methods. Retrospective review of the endoscopies performed from January 2005 through 2013. Results. Mean annual frequency of endoscopies increased by 25%. Main indication was suspected celiac disease and was followed by abdominal pain. The suspicion of eosinophilic disorder has increased significantly in recent years as a indication and as a finding in upper endoscopies. Lower encoscopies were associated with a high rate of normal results altough with a declining incidence over time. Conclusion. Pediatric gastrointestinal endoscopy performed by experienced encoscopist a sage technique. Changes in frequency, indications and results were observed in digestive endoscopic procedures that are consistent with the further development of the subspecialty and with the progress in the study of emerging diseases (AU)

Successful management of Churg-Strauss syndrome using omalizumab as adjuvant immunomodulatory therapy: first documented pediatric case.

Churg-Strauss syndrome (CSS) is an anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis; it is extremely rare in childhood and defined according to the Chapel-Hill Consensus as an eosinophil-rich and granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small to medium-sized vessels. Children commonly have a history of asthma and sinusitis whilst clinical presentation typically involves pulmonary tract and less frequently skin, heart, gastrointestinal tract, and peripheral nerves. Cardiopulmonary disease is higher in children and prognosis is worse. It is associated with significant eosinophilia and raised serum IgE-levels. ANCA are only found in 25% of childhood cases. Here we report the case of a 10-year-old girl who presented to us with vomiting, abdominal pain, and weight loss, paresthesias of lower extremities and breathlessness as well as a history of asthma, sinusitis and allergic rhinitis. She was treated with corticosteroids, cyclophosphamide, intravenous immunoglobulin, mycophenolate mofetil (MMF), and rituximab. However, remission was only achieved after initiation of omalizumab therapy, a recombinant humanized anti-IgE antibody. To the best of our knowledge this is the first pediatric patient suffering from CSS successfully managed with adjuvant anti-IgE therapy resulting in the control of respiratory as well as gastrointestinal symptoms.